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M Q,01 -79P1 <br />RECEIVED <br />Miming Operations APEN - Form APCD-22AN 18 2818 <br />Air Pollutant Emission Notice (APEN) and <br />A&V Application for Construction Permit ►- of Reclamation, <br />Mining & Safety <br />All sections of this APER and application must be completed for both new and existing facilities, Including APEN <br />updates. An application with missing information may be determined Incomplete and may be returned or result in <br />longer application processing times. You may be charged an additional APEN fee if the APEN Is filled out <br />incorrectly or Is missing Infornwdon and regmdres re -submittal. <br />This APEN is to be used for mining operations (i.e. quarries, pits, or mines). This APEN may also be used to report <br />haul road activities at non -mining facilities. Additional APENs may be required for process equipment located in <br />the mine. A specialty APEN may be available for the process equiparcnt (e.& asphalt plan% crushers/screens, <br />concrete batch plants, engines, etc.). if a specialty APEN is not available or does not satisfy your reporting needs, <br />the General APEN (Form APCD-200) Is available. A list of all available APEN forms can be found on the Air Pollution <br />Control Division (APCD) website at: www.colarado.mtov/cdahe/aocd. <br />This emission notice is valid for five (5) years. submission of a revised APEN is required 30 days prior to expiration <br />of the five-year term, or when a reportable change is made (significant emissions kxmme, increase production, <br />new equipment, charW In fuel type, etc.). See Regulation No. 3, Part A, II.C. for revised APEN requirements. <br />Permit Nurnber. 2017-02 7 MRS w Number: ! / <br />(Leave blank unless APCD ha% already assigned a permat �- and AIRS ID] <br />Section 1 - Adminktraflve information <br />Company Name': Graff Gravel, LLC <br />Mine/Pit Name: Graff Pit <br />Mine/Pit i00ti0n: NW1l4NE114 Sec.9,T15S,R95W, 6th P.M. <br />Lat: 38.76647 Long: -108.01369 <br />Mailing Address' 628 1800 Road <br />Delta, CO 81416 <br />Mine/Pit Location <br />qty: Delta <br />NAILS or SIC Code: 1442 <br />Permit Contact: Jared Graff <br />Phone Number: 970-201-3250 <br />E -Mail Address=: <br />t Use the full, legal company name registered with the Colorado Secretary of State. This is the company name that wet appear on <br />all documents turd by the APCD. Any changes will require addlttortal paperwork. <br />t Permits, exemption letters, and any processing invoices wit be issued by APCD via e-mail to the address provided. <br />ZL <br />CO►ONAao <br />Form APCD-ZZZ Mining Operations APEN - Revision 712017 1 j4mvr.. ►�,.";: ,. <br />